My best advice to you, dear reader: know thy breasts.
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THE FUTURE OF BREASTS
The world is too much with us; late and soon, Getting and spending, we lay waste our powers
—WILLIAM WORDSWORTH
IT WAS MID-AUGUST, TIME TO GET OUT OF THE LABS, TURN OFF the computer, and head for the mountains. I had a good excuse: a fundraiser for breast cancer research. I guilted my friends into donating some money, and I promised I would try to haul myself up three fourteen-thousand-foot peaks in one day. Thankfully, they are very close together. My team included five women and one very tall man wearing an Indiana Jones hat. He would be our beacon.
We were all climbing for different reasons. Lisa and Steve were climbing in honor of her mother. Natasha and Cindy were climbing for the camaraderie and a good cause. I was climbing in memory of my grandmothers, and for my daughter, in the hope that we may learn how to prevent breast cancer in time for her. Then there was Sherrie, whose daughter, Lesley, hadn’t been so lucky. She’d recently been diagnosed with breast cancer at the age of thirty-four.
Lesley, round faced and red cheeked, bundled in a puffy down jacket and headscarf, walked us to the trailhead at dawn. She distributed our T-shirts, which read, “Save Second Base,” then wished us well, and gave her mom a tight hug.
Sherrie shouldered her sizeable pack and thundered up the trail. At sixty-seven, she is built like a greyhound, sleek and muscle ripped. When she’s not climbing mountains, she’s a triathlete and ski instructor.
“What are you listening to?” I bellowed into her headphone pods, expecting a flavor of classical.
“Red Jumpsuit Apparatus,” she bellowed back. “I like alternative.”
A couple of hours later, at the summit of Mount Democrat in Colorado’s Mosquito Range, I learned that Sherrie’s nylon pack was like Mary Poppins’s carpet bag. Out came a smorgasbord of honey energy gels, goo packs, and other electrolyte snacks, enough for everyone for this and two more peaks.
Newly fortified, we admired the view. It was a glorious Rocky Mountain day: bluebird sky, granite peaks, patches of white snow sparkling in the sun, triangular green trees far below. For 360 degrees, from 14,148 feet, it was hard to discern any houses or roads. For a moment, it was easy to feel the world was as nature made it.
But then, to the West, what at first looked like a lake revealed itself to be a tailings pond. It was too rectangular and a strange color of turquoise. This was part of the Climax mine, owned by multinational giant Freeport-McMoRan Copper & Gold. Until recently, the mine was the world’s largest source of molybdenum, a trace element used to harden steel. Now it’s part of a notorious Superfund site. It was hard not to think about the cost of this pollution to the mountains and to our national budget, and then, directly or indirectly, to our breasts.
I’D RATHER JUST LOOK AT LUMINOUS, NEIGHBORING MOUNT Lincoln, no tailings in view. But this is the cropped way we’ve seen breasts, and it hasn’t done them much good. Scientifically, medically, and culturally, we have preferred to think of them as disembodied objects, removed from the rest of the human body and separate from the rest of nature.
In the early days of cancer treatment, surgeons believed if they could just hack off the tumor-ridden breast, the patient would survive. Alas, even radical mastectomies didn’t usually solve the problem. By the time the cancer was found, it was already invisibly wired to distant parts of the body. But the failure to recognize this cost many women needlessly painful and debilitating procedures. We were also slow to understand that pollutants could end up in breast cells and in breast milk. By insisting that breasts are sexually evolved and relegated to a sexual destiny, we have encouraged women not to value breast-feeding, and sadly, often not to value their normal, natural bodies.
Breasts have only slowly offered up their secrets, and we have been too distracted by their beauty to look very hard. As we’ve learned, breasts aren’t static, or pneumatic. They are always changing.
New bras, new lumps, new pride or despair, new glory, new fear.
WOMEN OFTEN TALK TO ME ABOUT THEIR BREASTS. THEY’LL TELL me that they’re donating some extra breast milk to a friend in need, or that their brother had breast cancer, or that their breasts are uneven. I’ll tell them about how humans are so unique to have rounded breasts all of our adult lives, how chimps’ breasts go back to being flat as Frisbees after nursing. “That happened to me!” they might joke. We’ll move on to other topics, like tonsils or tornadoes or Mrs. Dalloway. Sooner or later, though, the conversation usually comes back around. Friends and acquaintances ask where I stand on annual mammograms. Am I worried about false-positives? What about the radiation? I tell them the truth, which is that mammography is an archaic and deeply flawed technology, barely improved over fifty years. There are many false-negatives and false-positives, and, yes, there’s radiation, the only proven environmental cause of breast cancer. We can invent the Internet but not something better than blasting ions into our boobs using forty pounds of pressure?
So what do breasts need? ask my friends. Is there hope? Breasts desperately need a rosier future. They need a safer world more attuned to their vulnerabilities, and they need good listeners, not just good oglers. Breasts have some terrific allies, such as mountaineer/chemist Arlene Blum, who is fighting to get flame-retardants out of baby products and out of breast milk, and Susan Love, the brash surgeon who started a nonprofit to fund experimental research using a million human volunteers. Among the promising things Love is looking at: cheap tests of breast fluids to identify women at high risk of cancer. Then there is Rachel Ostroff, research director at SomaLogic. The Boulder-based biotech start-up is trying to identify proteins and enzymes in a routine blood sample that indicate the presence of an early breast tumor. Ostroff, whose sister died of breast cancer, calls these tiny protein biomarkers “the voices of life.” “We want to find the early evidence of disease when a cure is possible and simple,” she said.
These are heartening advances. The medical community is getting better at treating women with breast cancer. In 1944, only 25 percent of women with breast cancer survived ten years; by 2004, the number had increased to 77 percent. Ultimately, though, diagnostics and treatments are already measures of defeat: the tumor has arrived. We can save many women from dying of breast cancer, but that’s not necessarily going to save their breasts. To save breasts— and to spare women the particular agonies of this disease—we need to think more about the bigger picture of health and, ultimately, prevention. Yet surprisingly few national research dollars—about 7 percent of the budget of the National Cancer Institute—are spent on prevention, even broadly defined to include early screening. The cynic in me would point out that actually it’s not that surprising; there is little money to be made in preventing breast cancer compared to screening for it or treating it.
“It’s always been my belief that prevention will help us so much more than a cure,” said Saraswati Sukumar, a Johns Hopkins biochemist. With some help from the Dr. Susan Love Research Foundation, she’s pioneering “chemical mastectomies,” injecting chemotherapy through the milk ducts. Currently, the idea is to kill early, proliferating cells and allow women to keep their breasts. But eventually, says Sukumar, the procedure might become part of regular maintenance in high-risk women, akin to regularly cleaning out the pipes, Drano-style.
CALL ME A DREAMER, BUT I’D RATHER HAVE HEALTHY PIPES TO begin with. This is where prevention gets trickier. On a personal level, it means making vexing choices: drinking less alcohol, seeking alternative menopause treatments, exercising (a lot), scrutinizing labels, and reducing exposures to toxins and endocrine disruptors. These measures will take us only so far. A better and more successful approach would be a societal one, in which industries have incentives to design safer products and make healthier foods, and governments adopt a commonsense and rigorous approach to testing and regulating chemicals. Social policies could encourage more breast-feeding and less obesity.
When it comes to breasts, the ecosystem metaphor is apt. The new sciences of environmental disease and epigenetics are redefining the very notion of human nature. They’re challenging us to recall an ancient belief system that says we are deeply connected to our environment. Twentieth-century medicine had us believe our DNA was our destiny. Now we understand our DNA was built to bend. The pendulum of science is swinging away from the preeminence of the genetic code to the surprising power of our soil, air, water, and food. In this current cultural moment that worships technology and throwaway convenience, it’s a good time to remember our physical interdependence with the larger world. If breasts are to be saved, their salvation will lie in this recognition.
Much about our environment is better than ever. We have fewer parasites and infectious disease; most of us are protected from extreme weather and food shortages. On the whole, people in developed countries are smoking less and living longer than ever before. But when girls reach puberty earlier, their young lives face new and difficult challenges. Toxins in breast milk run the risk of affecting the cognitive, behavioral, and physical health of our children; and breast cancer will, on average, shave thirteen years off a woman’s life. We now understand health to be more than a measure of longevity. Our goal should be to live the best lives we can.
Decades ago, microbiologist-turned-humanist René Dubos argued for an ecological view of health. Health, he said, was not simply the absence of disease but the ability of the body to adapt to dynamic circumstances. Modern life appears to have compromised that ability in many ways. To safeguard our breasts, we need to protect our bodies’ biological processes. In this sense, the word ecosystem is no longer just a metaphor. Breasts are an ecosystem, governed by long-evolved functions, migrating molecules, and interconnected parts. Like every ecosystem, this one is highly adaptable, to a point.
Breasts are our sentinel organ. They offer us a window into our rapidly transforming world and the excuse to steward it better.
MUCH LIKE THE MOSQUITO MOUNTAINS, OR FREE-FLOWING RIVERS or polar ice caps, the human breast is a complex, unique, thrilling, beautiful thing, connected to the world in ways grand and infinitesimal. It’s an evolutionary miracle that we are only beginning to understand.
The fact that we can now talk so freely about breasts means our blind spots are getting smaller. More women are probing the role that industrial chemicals play in polluting our bodies and our breast milk. Every year, more scientific organizations issue proclamations on the need to research and regulate endocrine disruptors. Last year, an esteemed group of international researchers called on regulators in the United States and Europe to stop ignoring mammary glands when performing studies on lab animals. Those glands, they reminded us, may well be our most informative tissue.
As everybody knows, breasts can speak loudly. When we became aware of chemicals in breast milk, a powerful new lobby of mothers helped sweep DDT and PCBs off the marketplace. The same fate will likely befall brominated flame-retardants. But for scores of other chemicals, the science is young and the regulators often stripped of meaningful power. For the sake of breasts, let’s hope both of these conditions change. In the meantime, consumers have a few more options. Soon it will be possible to buy some kitchen plastics that don’t stimulate the estrogen receptor. Huzzah! It’s a start.
Breast cancer rates declined a few percentage points after 2003, probably because fewer women were taking hormonal replacement therapy. Unfortunately, the decline ended in 2007. Perhaps the HRT effect has gone as far as it will go, or perhaps other factors have started to fill in the vacuum. The search for all the interwoven causes of breast cancer will take a long, long time.
AFTER MY GRANDMOTHER GOT HER RADICAL MASTECTOMY IN 1973, a relative asked her how the wounds were healing. She replied she didn’t know because she refused to look.
There I was, thirty-eight years later, atop a mountain, considering the blue-green splotch of the Climax tailings pond and popping a cherry gel. Sherrie, my indefatigable hiking companion, pulled out her water bottle and camera, and then, slowly, she unfurled her homemade yellow sign for the summit photo: “For Lesley— and for Dan and Alli and for Mom, Bernie, Debbie, Maggie, Dad, George, Sheila, Stef, Staci, Shawn, For Courage … For Hope, and For Love.”
I’m with her. I didn’t have a sign, but I could have easily shouted down the soft flanks of the Mosquito Mountains that I was there for my daughter, my friends, and my grandmother who refused to look. It’s for them that I wanted to.
ACKNOWLEDGMENTS
IT CAN BE AWKWARD EXPLAINING TO PEOPLE THAT YOU’RE writing a book about breasts, but this project was met with great enthusiasm by many talented and helpful people. My agent, Molly Friedrich, is, like breasts, a force of nature. Her immediate and unwavering faith, along with that of Lucy Carson, propelled me and kept me afloat. I was lucky that Norton’s Jill Bialosky believed in this project from the beginning. This book was much improved by her editing and insight. I’d also like to thank the hard work of the copyeditor, Mary Babcock, and my publicist, Erin Lovett.
As I wrote this book, I kept pinching myself that I could be so lucky to dive into such a fascinating subject and the rich, varied research surrounding it. It was a privilege to engage with so many brilliant, dogged minds. I can’t list them all here, but I’m full of gratitude to the many people who took uncommon time to spend with a reporter. Numerous scientists and doctors welcomed me into their labs, offices, and conferences and sometimes read portions of the manuscript for accuracy: Olav Oftedal, Malcolm Pike, Irma and Jose Russo, Frank Biro, Larry Kushi, Zena Werb, Dan Sellen, Alan Dixson, Barnaby Dixson, Pepper Schedin, Patricia Hunt, Shelley McGuire, Peter Hartmann, David Newberg, Bruce German, Patricia Adair Gowaty, Ralph Wynn, Susan Love, Dixie Mills, Bernard Patten, Tom Biggs, and Michael Ciaravino and his patients. A handful of scientists helped me formulate interesting and telling ways to test my breasts, body, and home environment for various chemical substances; I’m grateful to Ruthann Rudel, Julia Brody, Heather Stapleton, Arlene Blum, Sonya Lunder, Andrea Kirk, Åke Bergman, Olaf Paepke, Arnold Schecter, and, at Axys Analytical Services, Barbara Carr. For their generous time and candor with their personal stories, a special thanks to Michael Partain, Pete Devereaux, and Timmie Jean Lindsey. The experts frequently set me straight, but any remaining mistakes are entirely my own.
I’m fortunate to have many supportive colleagues and friends who offered wisdom, edits, pep talks, babysitting, and the occasional enlivening Thai taco over the years of this project. Lisa Jones and Hannah Nordhaus were not only elegant role models but also went the extra mile with their red pens. Thanks to Ginny Jordan for inspiration and support, and thanks also to Hanna Rubin, Hillary Rosner, Melanie Warner, Claire Dederer, Tracy Ross, John Heyneman, Sandra Dal Poggetto, Brian Kahn, Caroline Patterson, Michelle Nijhuis, Paolo Bacigalupi, Page Pulver, Carin Chow, Susan Moran, Rachel and Jeff Walker, Deborah Fryer, Bonnie Sue Hitchcock, Curt Pesman, Andrea Banks, Auden Schendler, Anders Halverson, Peter Heller, Dan Baum, Beth Judy, Rebecca Stanfel, Rick Newby, Edward Lewine, Todd Neff, Joe Sorrentino, Sean Markey, Jim Levine, Betsy Tabor, Laura Tabor, Noah Harwood, Metta Gilbert, Lauren Seaton, Barbara McGill, and Danielle Garson. My friends and relatives, despite suffering bouts of neglect, offered sage counsel and various assistance. Thanks especially to Pamela Geismar and Pete Friedrich, Mara Rabin, Ann Vileisis, Margaret Nomentana, John and Galina Williams, Jamie and Wendy Friar, Terry and Joe Williams, Peter Williams, and Herr Professor Joe Williams Jr., whose scientific genius gives me inspiration and who del
ivered a much-needed private tutorial in statistics. Penny Williams took the Grandmother Hypothesis to new heights, moving in for weeks at critical times to feed and otherwise nurture us. Thanks also go to the occasional research assistance provided by Breanna Drexler, Jordan Wirfs-Brock, and Keirstin Kuhlman.
I was fortunate to have financial and administrative support for this project from the Ted Scripps Fellowship in Environmental Journalism and the Center for Environmental Journalism. At the University of Colorado, special thanks to Doña Olivier, Tom Yulsman, and Len Ackland. I’m grateful to the Lukas Prize Project Awards committee at Columbia University for honoring this manuscript as a distinguished finalist.
A number of relatives, friends, and friends of friends took me in during reporting trips or offered studio space so I could write: Betsy and Andy Baur, Ann Skartvedt and Mark Burget, Chuck and Molly Slaughter, Terry Hasshold, Philip Higgs, Chris Todd, Michael Kodas and Carolyn Moreau (and Otto, of course), Julie Frieder and Charlie Stanzione, Beth Conover and Ken Snyder, Garrett Finney and Sarah Newbery, Cyane Gresham and Alan Bayersdorfer, Violet Wallach, Jon Hoeber and Jenn Leitzes. I hope to return the favors.
Many fine magazine editors and teachers over the years have taught me much and indulged my curiosity, mammary and otherwise, in ways that supported this project: Ed and Betsy Marston, William Cronon, Fred Strebeigh, John Wargo, William Kittredge, Elizabeth Hightower, Emily Bazelon, Jennifer Rainey Marquez, Megan Liberman, Vera Titunik, Jamie Ryerson, Jonathan Thompson, Amy Linn, Toni Hope, Peter Flax, George Black, Laura Wright Treadway, and Alan Burdick.
Several books stand out as having particularly inspired, influenced, and cowed me: Natalie Angier’s Woman, Marilyn Yalom’s A History of the Breast, James S. Olson’s Bathsheba’s Breast, Siddhartha Mukherjee’s The Emperor of All Maladies, Sandra Steingraber’s Having Faith and Living Downstream, Rick Smith and Bruce Lourie’s Slow Death by Rubber Duck, and Linda Nash’s Inescapable Ecologies.
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